Peer-to-Peer and Physician Advisory Review Programs are a crucial part of driving quality improvement throughout healthcare organizations. They are key to helping organizations maintain credibility and support effective unbiased reviews. Thanks to the Affordable Care Act, consumers expect unbiased review of their care through the claims and appeals processes. Independent Review Organization have now been placed in the forefront of the healthcare industry.

Lately we have been talking about the important of Independent Review Organizations (IROs) and peer reviews in the healthcare ecosystem. Today we continue this discussion and delve deep into the importance of the peer review process. We know that peer reviews are a crucial part of healthcare because they hold medical professionals and organizations accountable in addition helping to build a world of trust between patient and physician. The peer review process is one that consists of high levels of property technology and superior customer service. By boosting transparency in healthcare, peer reviews have become an essential standard helping to make healthcare safer and more efficient. So let’s take a look at the 5 core building blocks of the peer review process.

BHM Healthcare Solutions’ Physician Advisor / Peer Review Services are expanding by leaps and bounds, creating the need for a new position, RN, IRO Clinical Manager, which lead the charge for future opportunities for growth and expansion.

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Do you need a new external review process?
Under the terms of the Affordable Care Act (ACA), many group health plans and health insurance issuers may be required to revise their claims appeal and review processes in order to comply with the terms of this legislation.

If you understand this infographic, you could work in Congress. In a nutshell, this infographic depicts the major departments and programs associated with regulating and administering healthcare and specifically Healthcare Reform or the Affordable Care Act.

"BHM provides consultation and direct clinical oversight to East Carolina Behavioral Health as a delegated authority for clinical peer review and physician services. We have been extremely satisfied, and value the organization’s depth and breadth of knowledge. BHM continues to exceed our expectations."

Cindy Ehlers,
V P Clinical Operations, Trillium (formerly ECBH)

"6 of the top 10 largest health plans* entrust BHM for behavioral health peer reviews.